Frequently Asked Questions

PDP

Q: What is a Prescription Drug Plan (PDP)?

A: Medicare Prescription Drug Plans (PDPs) are also known as Medicare Part D plans. Medicare Part D is a government program that offers prescription drug insurance for individuals who are entitled to Medicare Part A and/or enrolled in Medicare Part B. Once you become Medicare eligible, you must have creditable prescription coverage (at least as good as Medicare). Failure to have creditable coverage for 63 days or more could result in a Late Enrollment Penalty (LEP).

The federal government has specific guidelines for the types of medications that we must cover, as well as a minimum standard of benefits. Each plan has a formulary (list of covered medications) that meets these requirements that can be found in on your specific plan page, as required by law. Keep in mind, not all plans are the same. They may vary in cost or specific drugs covered. If you choose to enroll in a Medicare Part D plan, please review the plan's formulary and Evidence of Coverage to ensure it will meet your prescription drug coverage needs.

A: When looking for a PDP, you should take into consideration your monthly premium (to participate in the plan), deductibles (the amount you pay before the plan begins to pay), co-payments (amount you pay out-of-pocket for each prescription drug purchased) and whether the plan covers the drugs you take.

Q: Basic Medicare terms?

A: We want you to make an informed decision about your Medicare health plan. That's why we created a glossary to help you understand many commonly used Medicare terms.

Q: When can I enroll or make a plan change into a Prescription Drug Plan?

A: You can enroll or make a plan change into a WellCare Prescription Drug Plan three months before to three months after the month you turn 65. This is your Initial Coverage Election Period. You can also enroll in or switch to a new plan during the Open Enrollment Period (October 15-December 7 of every year) in which your new coverage would be effective January 1. There are other exceptions throughout the year that may allow you to make plan changes outside of the Initial Enrollment Period or Open Enrollment Period. Contact Customer Service for more information.

Q: How can I enroll in WellCare

A: You can enroll in a WellCare plan by choosing one of these options:

Enroll by mail - download, print and fill out our enrollment form and mail it to WellCare at P.O. Box 31411, Tampa, FL, 33631-3411.

Enroll over the phone - our representatives can enroll you right over the phone. Contact us to enroll.

Medicare beneficiaries may also enroll in WellCare plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

Q: Are my prescriptions covered by WellCare?

A: Look to your comprehensive formulary, which can be found on your plan's Drug List page and follow any formulary updates (if applicable) to see if your medications are covered by your WellCare PDP plan. The federal government has created guidelines for the types of drugs that must be covered, along with a minimum standard of benefits. Both brand-name and generic prescription drugs are covered by WellCare.

Q: One of my prescriptions is not on the WellCare formulary. What should I do?

A: Contact us and we can look up your prescription to see if it's part of our formulary (list of covered medications). When you call, one of our representatives may suggest an alternative medication. Please check with your doctor to see if that alternative would work for you. If your doctor feels that you need to take a certain brand name prescription drug that isn't covered, we have a review process in place that may allow you to do this. Read our Part D Transition Policy for what to do if your medication isn't covered by the plan.

Q: Where can I fill my prescriptions in 2017?

A: You can use your WellCare ID card at any of our 60,000 network retail pharmacies. Or, to save time and money when filling your prescriptions, use CVS/Caremark Mail Service Pharmacy, which will fill your prescriptions and mail them to your home. You will pay preferred (i.e. reduced) cost-sharing for prescriptions filled through CVS/Caremark Mail Service Pharmacy.

You have the choice to sign up for automated mail service delivery. You can get prescription drugs shipped to your home through our network mail service delivery program. You should expect to receive your prescription drugs within 7–10 business days from the time that the mail service pharmacy receives the order. If you do not receive your prescription drugs within this time, please contact us at 1-866-892-9006 (TTY 1-866-507-6135), 24 hours a day, seven days a week, or visit www.wellcare.com/medicare/mail_order_pharmacy_coverage.

Q: How can I save money on my prescription drug costs in 2016?

A: Using generic medications instead of brand-name drugs could help you save money. Generic drugs saved consumers $824 billion over the last decade, which is approximately $53 for every prescription sold.* Save even more by filling your prescriptions through our mail-service pharmacy that offers preferred cost-sharing. By filling your prescription through CVS/Caremark Mail Service Pharmacy, which offers preferred cost-sharing, you will pay $0 for a three-month supply of Preferred Generic (Tier 1) medications. For all other drugs (excluding our Specialty tier, and, in most cases, our Non-Preferred Brand Tier), you will get a three-month supply for only 2 1/2 co-payments. Best of all, standard shipping is always free.

A: Using generic medications instead of brand-name drugs could help you save money. Generic drugs saved consumers $824 billion over the last decade, which is approximately $53 for every prescription sold.* Save even more by filling your prescriptions through CVS/Caremark Mail Service Pharmacy, which offers preferred cost-sharing. You will pay $0 for a three-month supply of Preferred Generic (Tier 1) medications. For all other drugs (excluding those in our Specialty tier, and, in most cases, our Non-Preferred Brand Tier), you will get a three-month supply for only 2 1/2 co-payments. Best of all, standard shipping is always free.

Q: What if I am on a limited income or cannot afford my prescription drugs?

A: You may qualify for Extra Help from the federal government - and if you are eligible, this assistance program could help you pay for some of your drug costs. To learn more, please contact us.

Q: Can WellCare refuse me coverage if I take a lot of prescriptions?

A: As long as you are eligible, WellCare cannot refuse to offer you coverage.

Q: Should I still keep my red, white and blue Medicare card?

A: Yes. However, as long as you are a member of our plan, you must not use your red, white and blue Medicare card to get covered medical services (with the exception of clinical research studies and hospice services). Keep your red, white and blue Medicare card in a safe place in case you need it later. Here’s why this is so important: If you get covered services using your red, white and blue Medicare card instead of using our membership card while you are a plan member, you may have to pay the full cost yourself. If your WellCare ID card is damaged, lost or stolen, contact us right away and we will send you a new card.

Q: What if I have to pay cash for my prescription because I do not have my WellCare ID card?

A: You can ask us to pay you back by completing a Direct Member Reimbursement Form and mailing it to us. Please keep a copy of the form and receipts for your records. We will mail you a letter within 7 to 10 days with our decision concerning your request for reimbursement.

Q: How do I start receiving my prescriptions through mail service delivery?

A: You can choose one of three ways to start using CVS/Caremark mail service delivery to fill your prescriptions:

Provide the requested information, and CVS/Caremark will contact your doctor for a 90-day prescription. If you haven’t registered on Caremark.com yet, be sure to have your benefit ID number (BIN) handy when you register for the first time. This number can be found on your WellCare ID card.

Call the FastStart® toll-free number: 1-800-875-0867. When you call, be sure to have:

The benefit ID number (BIN) from your WellCare ID card

Your doctor’s first and last name and phone number

Your payment information and mailing address

CVS/Caremark will let you know which prescriptions can be filled through mail service. Your doctor will then be contacted for a 90-day prescription and your medication will be mailed to you.

Fill out and send a mail service order form. Please have the following information with you when you complete the form:

The benefit ID number (BIN) from your WellCare ID card

Your complete mailing address, including zip code

Your doctor’s first and last name and phone number

A list of your allergies and other health conditions

Your credit or debit card number if you prefer that method of payment. You can also pay by check, electronic check, PayPal Credit or money order (Cash is NOT accepted)

Our original prescription from your doctor for up to a 90-day supply

Allow up to 10 days from the day you submit your order for delivery of your medicine. Regular delivery is free. Overnight or second-day delivery is available for an additional charge.Q: I have already signed up to receive my medications through mail service. How do I order refills?

A: There are 3 ways to refill:

Online. Ordering refills at Caremark.com is convenient, fast and easy! Register online to receive refill reminders and other important updates. Have your benefit ID card handy to register.

By Phone. Call the toll-free Customer Care number on your prescription label for fully automated refill service. Have your benefit ID number (BIN) ready. This number can be found on your WellCare ID Card.

By Mail. You will receive an order form with every mail service order. Simply fill in the ovals for the refills you want to order. If you need a refill for a prescription not listed on the form, write the prescription number in the space provided. Send the form to CVS/Caremark along with your payment.

Allow up to 10 days from the day you submit your order for delivery of your medicine. Regular delivery is free. Overnight or second-day delivery is available for an additional charge.

If you’d like to receive automatic refills and renewals, you can try ReadyFill at Mail®. Here’s how ReadyFill at Mail works:

When you enroll qualified prescriptions in ReadyFill at Mail, CVS/Caremark will automatically refill your prescriptions at the appropriate time, unless you cancel.

CVS/Caremark will also contact your doctor to renew your prescription once the last refill is up or the prescription is about to expire.

CVS/Caremark will contact you twice before you receive your prescription delivery. The first message is sent by e-mail, phone or text message 14 days before your refill due date to let you know your order is being placed. If you need to cancel the order, you can do so at that time. A second message is sent five to seven days before your refill due date to let you know that your order has shipped.

If a copay is required, you will ONLY be charged when your prescription ships.

To enroll in ReadyFill at Mail, register or sign in to www.Caremark.com/ReadyFill, then go to the “Manage Your Prescriptions” page. Select the eligible prescriptions you want to enroll and follow the steps. Or call Customer Care at 1-800-552-8159. They will tell you which prescriptions can be enrolled in ReadyFill at Mail.

Q: What if I mailed my request for WellCare to pay for my prescriptions, but I have not received any information?

A: If after 10 days, you have not received your letter with our decision, please contact us. We will provide you information, including whether or not we received your request.

Q: What is coverage gap?

A: The coverage gap occurs when you and WellCare have spent a predetermined amount of money for your Part D covered prescription drugs. After that, your PDP coverage will change.

Q: Should I use generic drugs?

A: Generic medications are FDA-approved and can help you stay out of the coverage gap. They can also save you money.

Q: What is a Late Enrollment Penalty (LEP)?

A: A late enrollment penalty is an amount added to your Medicare Part D premium. You may owe a late enrollment penalty if, at any time after your initial enrollment period is over, there is a period of 63 days or more in a row when you do not have Part D or other creditable prescription drug coverage. This amount will apply regardless of the prescription drug plan you select.

A: A network pharmacy is a pharmacy that has a contract with the plan to provide your covered prescription drugs.
Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available. There are certain circumstances, in which we may cover prescriptions filled at an out-of-network pharmacy, such as when you are traveling or in a medical emergency. In normal circumstances, if you must use an out-of-network pharmacy, you'll have to pay the full cost of the drug (rather than your normal share of the cost) when you fill your prescription. You can ask us to reimburse you for our share of the cost by completing a Direct Member Reimbursement form.

Q: Do I have to use my ID card?

A: Yes, be sure to use your ID card anytime you fill a prescription, even if the pharmacy's cost of the medication is lower that the plan's co-payment. By using your ID card, it will ensure that your out-of-pocket expenses for prescription drugs are tracked accurately, and help you get through each of the benefit stages.

Q: I filled my prescription at a CVS pharmacy and was charged the standard retail cost-sharing. I thought CVS offers preferred cost-sharing?

A: CVS offers preferred cost-sharing for prescriptions filled through their mail-service. Prescriptions filled at a CVS retail location will be charged the standard cost-sharing rate.

Q: What would happen if I cannot pay my monthly premium

A: If you are having a hard time paying your monthly premium, you may want to look into Low-Income Help. Many people qualify for Extra Help and do not know it. If you do not make your premium payment and are not receiving Extra Help, you can be disenrolled from your plan. Refer to your Evidence of Coverage, on your plan-specific page, for details.

Q: I get some of my prescriptions through Medicare Part B. Now what?

A: You'll continue to get them through Part B. Prescriptions received as part of a physician's services or due to surgery, along with certain Part B prescription drugs, are covered through Part B. Please contact us if you need more information.

Q: I would like to get a three-month supply of my drugs. Is that possible?

A: You can get an extended-day supply of most drugs when you use a pharmacy that offers extended-day supplies. Please call your pharmacy beforehand to confirm it offers a three-month supply.

Q: I was at the pharmacy and was told I do not have coverage. What should I do?

Medicare

Q: What is a Medicare Advantage HMO plan?

A: A Medicare Advantage HMO plan is offered by a private company that contracts with Medicare to provide you with all your Medicare Part A (hospital) and Part B (medical) benefits. It is a health maintenance organization, or HMO. That means it provides care through a network of providers. Care is coordinated through the primary care physician (PCP), who may refer people to specialists as needed. Referrals are generally required to see specialists.

Q: What is a Medicare Advantage HMO POS plan?

A: A Medicare Advantage HMO POS also provides care through a network of providers. However, it includes a point of service (POS) feature, which allows members to receive health care services outside of the network with authorization from the plan, although use of providers within the network is encouraged.

Q: What is a network?

A: A network is a group of doctors and other health care professionals, medical groups, hospitals and other health care facilities that have an agreement with us to deliver covered services to members in our plan. The providers in our network generally bill us directly for care they give you. When you see a network provider, you usually pay only your share of the cost for their services.

Q: Where can I get information about basic Medicare terms?

A: We want you to make an informed decision about your Medicare health plan. That's why we created a glossary to help you understand many commonly used Medicare terms.

Q: Should I still keep my red, white and blue Medicare card?

A: Yes. However, as long as you are a member of our plan you must not use your red, white and blue Medicare card to get covered medical services (with the exception of clinical research studies and hospice services). Keep your red, white and blue Medicare card in a safe place in case you need it later. Here's why this is so important: If you get covered services using your red, white and blue Medicare card instead of using our membership card while you are a plan member, you may have to pay the full cost yourself. If your WellCare ID card is damaged, lost or stolen, contact us right away and we will send you a new card.

Q: If I do not like my WellCare plan, can I go back to Original Medicare?

A: Of course. You do not lose your Medicare benefits when you join our plan. However, there are limits on when and how often you can change your Medicare Advantage plan. Contact us to find out more.

Q: When can I enroll or make a plan change into a WellCare Medicare Advantage Plan?

A: You can enroll or make a plan change into a WellCare plan three months before to three months after the month you turn 65. This is your Initial Coverage Election Period. You can also enroll during the Open Enrollment Period (October 15-December 7 of every year), in which your new coverage would be effective January 1. There are also exceptions throughout the year that may allow you to make plan changes outside of the Open Enrollment Period. Contact us for more information.

Q: How do I start receiving my prescriptions through mail service delivery?

A: You can choose one of three ways to start using CVS/Caremark mail service delivery to fill your prescriptions:

Provide the requested information, and CVS/Caremark will contact your doctor for a 90-day prescription. If you haven’t registered on Caremark.com yet, be sure to have your benefit ID number (BIN) handy when you register for the first time. This number can be found on your WellCare ID card.

Call the FastStart® toll-free number: 1-800-875-0867. When you call, be sure to have:

The benefit ID number (BIN) from your WellCare ID card

Your doctor’s first and last name and phone number

Your payment information and mailing address

CVS/Caremark will let you know which prescriptions can be filled through mail service. Your doctor will then be contacted for a 90-day prescription and your medication will be mailed to you.

Fill out and send a mail service order form. Please have the following information with you when you complete the form:

The benefit ID number (BIN) from your WellCare ID card

Your complete mailing address, including zip code

Your doctor’s first and last name and phone number

A list of your allergies and other health conditions

Your credit or debit card number if you prefer that method of payment. You can also pay by check, electronic check, PayPal Credit or money order (Cash is NOT accepted)

Our original prescription from your doctor for up to a 90-day supply

Allow up to 10 days from the day you submit your order for delivery of your medicine. Regular delivery is free. Overnight or second-day delivery is available for an additional charge.Q: I'm signed up to get my medications via mail service. How do I order refills?

A: There are 3 ways to refill:

Online. Ordering refills at Caremark.com is convenient, fast and easy! Register online to receive refill reminders and other important updates. Have your benefit ID card handy to register.

By Phone. Call the toll-free Customer Care number on your prescription label for fully automated refill service. Have your benefit ID number (BIN) ready. This number can be found on your WellCare ID Card.

By Mail. You will receive an order form with every mail service order. Simply fill in the ovals for the refills you want to order. If you need a refill for a prescription not listed on the form, write the prescription number in the space provided. Send the form to CVS/Caremark along with your payment.

Allow up to 10 days from the day you submit your order for delivery of your medicine. Regular delivery is free. Overnight or second-day delivery is available for an additional charge.

If you’d like to receive automatic refills and renewals, you can try ReadyFill at Mail®. Here’s how ReadyFill at Mail works:

When you enroll qualified prescriptions in ReadyFill at Mail, CVS/Caremark will automatically refill your prescriptions at the appropriate time, unless you cancel.

CVS/Caremark will also contact your doctor to renew your prescription once the last refill is up or the prescription is about to expire.

CVS/Caremark will contact you twice before you receive your prescription delivery. The first message is sent by e-mail, phone or text message 14 days before your refill due date to let you know your order is being placed. If you need to cancel the order, you can do so at that time. A second message is sent five to seven days before your refill due date to let you know that your order has shipped.

If a copay is required, you will ONLY be charged when your prescription ships.

To enroll in ReadyFill at Mail, register or sign in to www.Caremark.com/ReadyFill, then go to the “Manage Your Prescriptions” page. Select the eligible prescriptions you want to enroll and follow the steps. Or call Customer Care at 1-800-552-8159. They will tell you which prescriptions can be enrolled in ReadyFill at Mail.

Q: How do members get permission to receive services?

A: Members can get service authorizations from their primary care provider (PCP) or from specialists they were referred to by their PCP.

Q: Will I have the same coverage as I do with Original Medicare?

A: Our plans are required to cover all services and procedures that are covered by Original Medicare. However, our plans also offer extra benefits not covered by Original Medicare, which may include routine dental, routine hearing, routine vision and prescription drug coverage. Please note that, as a member of our plan, your use/participation in a limited number of services, such as clinical research studies and hospice services, will be paid for directly by Medicare. Becoming a member of our plan does not make you ineligible to receive these services.

Q: Can I receive emergency care?

A: You have the right to emergency care, when needed, anywhere in the United States and without pre-approval from us.

Q: Do HMO or HMO POS plans cover services that Medicare does not consider medically necessary?

A: An HMO or HMO POS plan is not required to pay for services that are not medically necessary under Medicare. However, WellCare plans do pay for additional benefits not covered by Original Medicare. If you receive a service that is not covered by our plan, you are responsible for the cost of that service. If you are not sure whether a service is covered, you have the right to call us and ask for an advance decision.

Q: What do I need to do to get care?

A: Our plans work just like a traditional health insurance. Just show your WellCare Member ID card (instead of your Medicare card) at the doctor's office. You may have a co-payment due at that time.

Q: What happens if my doctor is not familiar with WellCare Plans?

A: If your doctor or health care provider would like more information about WellCare, ask him or her to contact us. Our Customer Service representatives are ready to answer questions.

Q: Can WellCare ever drop my coverage?

A: Once you are enrolled, you cannot be disqualified for any medical condition. However, if you move out of our service area or commit fraud, WellCare reserves the right to disenroll you. All Medicare Advantage plans commit to their members for a full year. Each year, WellCare decides whether to continue a plan for another year. Even if a Medicare Advantage Plan is discontinued at the end of a benefit year, you will not lose Medicare coverage. If your plan is discontinued, WellCare must notify you in writing at least 60 days before your coverage ends. The letter will explain your other options for Medicare coverage in your area.

Q: What if I need to talk to a nurse?

A: One of the perks of being a WellCare member is our 24-hour Nurse Advice Line at 1-800-581-9952. (TTY users dial 711) Our nurses will give you answers to your medical questions and help you decide whether or not to see your doctor or go to the emergency room. Nurses are available 24 hours a day, 7 days a week. You can also find the number on the back of your Member ID card.

Q: Do I still have to pay my Medicare Part B premium?

A: Yes. When you join a WellCare plan, you must continue to pay your Medicare Part B premium unless it's paid for you by Medicaid or another third party. If you meet certain eligibility requirements for both Medicare and Medicaid, your Part B premium may be covered in full. Some of WellCare's Plans help by reducing your Medicare Part B premium. The reduction is set up by Medicare and administered through the Social Security Administration (SSA). Depending on how you pay your Medicare Part B premium, your reduction may be credited to your Social Security check or credited on your Medicare Part B premium statement. Reductions may take several months to be issued. However, you will receive a full credit.

Provider

Q: How do I join WellCare?

A: Please complete our Become a Provider form or contact us for more information on how to join our network. If you want to join our Medicaid provider network, please be sure to visit your state-specific Medicaid website to submit a request.

Q: I forgot my provider ID number. Where can I find it?

A: Please check your WellCare welcome letter. You can also use the Contact Us form for additional help.

A: We ask that you contact your local District Sales Manager as your direct line of support. These managers are familiar with your particular area and are best suited to support you on a local level with anything from supplies and training questions to enrollment and commission issues. If you have any questions or need assistance, please contact your local District Sales Manager.